title: Comorbid posttraumatic stress disorder and opiate addiction: a literature review.
abstract: Treatment of comorbid posttraumatic stress disorder (PTSD) and opioid dependence has been a challenge for many clinicians. There are limited evidence-based guidelines for treatment of this comorbidity. Symptoms of PTSD and opiate dependence may converge, and it is sometimes difficult to differentiate between both conditions. For example, opioid withdrawal symptoms may mimic the hypervigilance and exacerbated startle response of patients with PTSD. A common neurobiologic circuit is suggested for the pathophysiologic mechanism of this comorbidity. There is evidence that opioid substitution therapy may improve treatment outcomes for opioid addiction in patients with comorbid PTSD and opioid dependence. Evidence-based psychotherapeutic intervention is recommended for this population to improve the psychological outcome as well. Combining opioid substitution therapy with evidence-based cognitive behavioral therapy designed for individuals with comorbid PTSD and substance abuse (e.g., Seeking Safety) may improve treatment outcomes in this population. More research is needed to understand the underlying mechanisms for this comorbidity and to improve treatment response.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. ayman.fareed@va.gov
authors.forename: Ayman
authors.initials: A
authors.lastname: Fareed
authors.forename: Pamela
authors.initials: P
authors.lastname: Eilender
authors.forename: Michael
authors.initials: M
authors.lastname: Haber
authors.forename: James
authors.initials: J
authors.lastname: Bremner
authors.forename: Natasha
authors.initials: N
authors.lastname: Whitfield
authors.forename: Karen
authors.initials: K
authors.lastname: Drexler
mesh_terms: D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D009294:Narcotics / Q000009:adverse effects; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D011379:Prognosis; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation
chemical_list: D009294:Narcotics